venlafaxine- when to increase?

[vintagefiend]

I have had a severe decline in mental well-being particularly in line with hormonal changes. It started with PND mid thities, then pms/pmdd in late thirties but now that I'm mid forties and prob nigh-on perimenopausal, it's become virtually continuous depression with spikes at "hormonal" times of the month.
I have tried various hormonal treatments to no avail- difficult to calibrate, I think- when not actually menopausal but all over the place!
I was initially resistant to SSRI but now I feel so lousy I will take anything, lifelong if needs be!
Citalopram doesn't work so I have started venlafaxine...my regime has been:
6 days at 37.5 mg
a further 6 days at 75 mg
a further 6 days at 112.5 mg
and now 9 days at 150 mg
So it's been a month and I feel pretty up and down (well, down and very down!)- right now I'm functioning but not great...yesterday I felt suicidal- so so down- surely I should be feeling something positive after a month?
Should I give the 150 mg a bit longer to work or should I ask for 225 mg increase- my GP really knows sweet FA so I really feel it's my call! Thanks
(also does anyone know if perimeno/hormonal stuff has an impact on norepinephrine?)

by the way, when i say i was "resistant" to ssris, i mean i didn't like the idea of them rather than being physiologically resistant (although i prob am "immune" to citalopram)

I have bipolar and in my last severe episode I started on Venlafaxine as Citalopram made me very apathetic win zero motivation which wasn't that much better than being depressed.

I don't remember the exact time I spent at each dose but I went from 75mg to 150mg to 225mg quite quickly.

My (private and very good) psych advised that you should really notice a different in 7-10 days if it's working as it builds up in the body very quickly compared to Citalopram (which can take a month).

My experience was that I didn't notice much improvement until I went onto 225mg and then about 3-5 days later it was like a light switch had been flicked - the light came on and the darkness disappeared all of a sudden.

Might work differently with you of course as psych meds do work very differently from one person to another and the fact that my depression is bipolar rather than unipolar may make a different but that's my experience FWIW.

for the time being....I know how much being depressed sucks.

thank you- stumbly really appreciate your taking the time to reply.
very helpful!
really interesting that you noticed a quick difference in mood when u increased dose- i must admit, my gut feeling is that i should feel something by now. i've had antidepressants sporadically throughout my life (mid twenties onwards) and i did always notice a fairly immediate effect.
also what i considered depressive episodes in my twenties were nothing like what i'm experiencing now (or post natally, for that matter)- i just feel that my depression is much more severe and i probably need a more heavy duty dose! although is 225mg heavy duty?- i'm a bit in the dark!
i have seen a good gynae privately and he's talked of increasing and decreasing anti-deps according to menstrual cycle. i'm interested in trying this but obvs i need to find the drug that will work first!
i hadnt realised that venlafaxine tends to work more quickly than other ssris- i'd actually thought it was one of the slower ones so thanks for enlightening me!
and thanks for the flowers

Yes...225mg is usually the most they will prescribe.

If it doesn't work alone the next step would usually be to do continue the Venlafaxine and add in Mirtazpine. This is apparently known as 'Californian rocket fuel'

Venlafaxine and Mirtazipine combo is used quite often for stubborn depression. Another med that can be used alongside Venlafaxine is Agomelatonin which is quite new and should be taken at night.

These are combos you can take if Venlafaxine on its own doesn't work.

As it happens we're now TTC our first baby so I've now dropped down to 150mg and seem to be fine on that even though it didn't work at the time. I may have needed a higher dose to kick depression's arse in the first instance but now I'm better seem to manage on 150.

My psych is talking about trying 75mg soon but I'm still thinking about that as I was made redundant last week so not sure it's great timing (but on the other hand best to be on the lowest dose possible for conceiving).

Have you been able to figure out whether anything else lifestyle wise helps?

I work less (was a workaholic), sleep more, have quit partying and drinking and try to exercise more (with varying success) and that seems to have helped to level me out too along with all the therapy I did when I was in hospital.

thanks again stumbly- yes i've heard of this rocket fuel and i'll keep it as a possibility- is it that it's more than the sum of its parts or something?! just hits all the right bits?
i actually didnt feel too bad when i last responded and was half thinking that i'll give 150mg a bit longer but i've hit a real low now and dont feel so sure it'll work!
i'm always convinced when i feel ok that that's it(i'm out of the woods) but that's not the nature of the beast!
i'm reassured that you've been able to decrease with relative ease- one of the things i was worried about was being able to decrease from a high dose at some point in the future.
i wish you the very best of luck with conceiving- have fun!!
very sorry to hear you've been made redundant- i havent been able to work due to all this but look forward to gainful employment at some point- tho just cant imagine it right now!
i havent been able to exercise as cant go out the house and shattered anyway but i'm really hoping that the venlafaxine will enable me to address all the things i can't be arsed to right now!
i actually can't wait to have a healthy lifestyle- which sounds so boring- but i need a kick start to do it!
anyway i'll give it a few more days and then consider increasing venlafaxine- i have a lovely neighbour who is a doctor specialising in this area and she's always said she's happy to help me if i want- i've always been a bit british and resisted but that's silly! she, herself has bipolar which is probably what makes her so empathetic!
cheers x

I know this is a long time ago. I'm basically in exact same situation as you. Did the 225 mg work for you? Xxx